Dayspring Christian Academy & Preschool (ages 6weeks-VPK) Enrollment Application

Dayspring Christian Academy & Preschool (ages 6weeks-VPK) Enrollment Application
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Pre-Kindergarten Programs Registration
Desired Start Date

MonthDayYear
Date
Student Information
Name

First NameLast Name
FemaleMale
Birth Date

MonthDayYear
Date
Home Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 1
Full Name

First NameLast Name
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 2
Full Name

First NameLast Name
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent 1Parent 2Both ParentsOther
Medical Information

I herby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.
Doctor's Name

First NameLast Name
Doctors Phone Number
Format: (000) 000-0000.
Doctor's Name

First NameLast Name
Doctors Phone Number
Format: (000) 000-0000.
Please list allergies, special medical or dietary needs, or others areas of concern. Also give any Emergency Care Plan Instruction (if applicable)
YesNo
YesNo
Does your child require any medication? If yes, please list these medications.
Emergency Contact - Other than Parent/Guardian

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from teh facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached:
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
Emergency Contact - Other than Parent/Guardian

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from teh facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached:
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
Emergency Contact - Other than Parent/Guardian

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from teh facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached:
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
Emergency Contact - Other than Parent/Guardian

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from teh facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached:
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Should be Empty:

Dayspring Christian Academy & Preschool (ages 6weeks-VPK) Enrollment Application

Pre-Kindergarten Programs Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Medical Information

Emergency Contact - Other than Parent/Guardian

Emergency Contact - Other than Parent/Guardian

Emergency Contact - Other than Parent/Guardian

Emergency Contact - Other than Parent/Guardian